Changes in caseload and the potential impact on surgical training: a retrospective review of one hospital's experience

The number of elective procedures carried out in each surgical specialty (General & Vascular Surgery, Urology, Orthopaedics, ENT) in a large district general hospital was analysed in 6 month periods and adjusted for the number of basic surgical trainees in each specialty. In order to allow comparison between specialties, results for each 6 month period were calculated as a percentage of those for the first period.The number of elective operations available per trainee fell in 3 of the 4 specialties, with a rise in Orthopaedics. Overall, the number of operations available to each trainee was 56% of that less than a decade ago.The number of operations available in a conventional hospital setting is decreasing. Introduction of the Modernising Medical Careers reforms must take account of this if they are to succeed in improving the quality of surgical training.Surgical training in the UK has undergone numerous reforms, from the Calman report to the implementation of the European Working Time Directive, which have combined to reduce length of training, normal working hours and exposure to out-of-hours emergency procedures [1,2] placing "serious challenges" on gaining sufficient experience[3].The current Modernising Medical Careers[4] reforms seek to address this situation with the implementation of seamless training. The plans call for an initial broad base to training with a two-year foundation scheme, followed by specialist training of between 5 and 10 years depending on the specialty and concluding with the award of a Certificate of Completion of Training[5].Previous studies have shown that trainees have less experience than their forebears, in both emergency and elective work [6,7] and that the impact of previous reforms has resulted in the majority (86.5%) of learning opportunities coming from surgical activity during normal working hours[8]. If training reforms are to be implemented appropriately, it is important to understand the nature of available resources in o